title: Knowledge is insufficient for self-care among heart failure patients with psychological distress.
abstract: OBJECTIVE
  We conducted a study to identify barriers to, and factors promoting, self-care among heart failure (HF) patients with higher or lower levels of knowledge.
  
  
  METHODS
  Baseline data from 612 patients with HF enrolled in the REMOTE-HF trial were analyzed. Using median splits on the HF Knowledge Scale and the European HF Self-Care Behavior Scale, patients were divided into four groups: (a) low knowledge and good self-care, (b) low knowledge and poor self-care, (c) high knowledge and good self-care, and (d) high knowledge and poor self-care. Characteristics of the groups were compared using ANOVA, Kruskal-Wallis tests, and chi-square tests, followed by pairwise tests with Bonferroni correction. Variables significant in the univariate analyses were evaluated as predictors of self-care using hierarchical multiple linear regression. The potential moderating effect of knowledge was tested with interaction terms.
  
  
  RESULTS
  The four groups did not differ in sociodemographics or health literacy scores, but differed in New York Heart Association (NYHA) class, comorbidities, and scores on depression, anxiety, and perceived control. In post hoc pairwise tests, patients with high knowledge and poor self-care tended to have worse NYHA class, greater depression and anxiety, and lower levels of perceived control than others. In the multivariate analysis, knowledge, depressive symptoms, and perceived control were significant predictors of self-care, as was the interaction between knowledge and anxiety.
  
  
  CONCLUSIONS
  Screening and treatment of depression and anxiety is important in improving self-care among HF patients. HF management programs need to include strategies for increasing patients' perceived control over their heart disease.
authors.affiliation: School of Nursing, University of California-Los Angeles.
authors.forename: Boyoung
authors.initials: B
authors.lastname: Hwang
authors.affiliation: College of Nursing, University of Kentucky.
authors.forename: Debra K
authors.initials: DK
authors.lastname: Moser
authors.affiliation: School of Nursing, University of California-San Francisco.
authors.forename: Kathleen
authors.initials: K
authors.lastname: Dracup
mesh_terms: D000368:Aged; D001007:Anxiety / Q000175:diagnosis; D003430:Cross-Sectional Studies; D003863:Depression / Q000175:diagnosis; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D057220:Health Literacy / Q000706:statistics & numerical data; D006333:Heart Failure / Q000523:psychology* / Q000628:therapy*; D006801:Humans; D007389:Internal-External Control; D008297:Male; D008875:Middle Aged; D012648:Self Care / Q000523:psychology*; D013315:Stress, Psychological / Q000523:psychology*